Xu Chennian, Liu Yang, Zhai Mengen, Jin Ping, Li Lanlan, Ma Yanyan, Yang Jian
Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China.
Front Cardiovasc Med. 2022 May 20;9:750896. doi: 10.3389/fcvm.2022.750896. eCollection 2022.
Closure of a percutaneous paravalvular leak (PVL) is a technically challenging procedure because of the specific anatomy postoperatively and the complex catheter techniques required. Transesophageal echocardiography (TEE) and three-dimensional (3D) printing might be helpful in identifying complex anatomical structures and the procedural design.
The purpose of this study was to review our experiences with transcatheter closure of PVL guided by TEE and 3D (TEE&3D) printing.
A total of 166 patients with PVL after surgical valve replacement underwent transcatheter closure, from January 2015 through December 2020. Among these patients, 68 had preoperative guidance from TEE&3D printing. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up period was 36 (3-70) months.
Acute procedural success was achieved in 154/166 (92.8%) patients; of these, 64/68 (94.1%) had TEE&3D guidance and 90/98 (91.8%) had transthoracic echocardiography (TTE) guidance. No hospital deaths occurred. All patients having percutaneous procedures were given local anesthesia, while 13 patients having transapical procedures were given general anesthesia. Multiple approaches were used, including transfemoral, transapical, and transseptal the arteriovenous loop. We also deployed multiple devices, including the Amplatzer Vascular Plug II (AVP II), the Amplatzer duct occluder II, the patent ductus arteriosus (PDA) occluder, and the Amplatzer muscular ventricular septal defect occluder. Those cases guided by TEE&3D printing had shorter procedural times compared with those guided by TTE [(61.2 ± 23.4) vs. (105.7 ± 53.9) min, < 0.05]. The fluoroscopic time was also shorter for operations guided by TEE&3D printing compared with those guided by TTE alone [(18.5 ± 11.4) vs. (27.3 ± 5.6) min, < 0.05]. The complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. There was no significant difference in the incidence of complications between the 2 groups.
Transesophageal echocardiography and 3D printing show advantages compared with standalone TTE in guiding the transcatheter closure of PVL with shorter procedural and fluoroscopic times. This minimally invasive treatment could provide reliable outcomes in selected patients.
[www.ClinicalTrials.gov], identifier [NCT02917980].
经皮瓣周漏（PVL）封堵术是一项技术要求高的操作，因为术后解剖结构特殊且需要复杂的导管技术。经食管超声心动图（TEE）和三维（3D）打印可能有助于识别复杂的解剖结构和进行手术设计。
本研究旨在回顾我们在TEE和3D（TEE&3D）打印引导下经导管封堵PVL的经验。
2015年1月至2020年12月，共有166例外科瓣膜置换术后发生PVL的患者接受了经导管封堵术。其中，68例患者术前接受了TEE&3D打印指导。我们回顾了导管技术、围手术期特征和预后情况。中位随访期为36（3 - 70）个月。
154/166（92.8%）例患者手术即刻成功；其中，64/68（94.1%）例接受TEE&3D指导，90/98（91.8%）例接受经胸超声心动图（TTE）指导。无院内死亡发生。所有接受经皮操作的患者均采用局部麻醉，13例接受经心尖操作的患者采用全身麻醉。采用了多种入路，包括经股动脉、经心尖和经房间隔 - 动静脉环。我们还使用了多种装置，包括Amplatzer血管封堵器II型（AVP II）、Amplatzer动脉导管封堵器II型、动脉导管未闭（PDA）封堵器和Amplatzer肌部室间隔缺损封堵器。与TTE指导的病例相比，TEE&3D打印指导的病例手术时间更短[（61.2 ± 23.4）分钟 vs.（105.7 ± 53.9）分钟，P < 0.05]。与单纯TTE指导的手术相比，TEE&3D打印指导的手术透视时间也更短[（18.5 ± 11.4）分钟 vs.（27.3 ± 5.6）分钟，P < 0.05]。并发症包括反复溶血、残余反流、急性肾功能不全和贫血。两组并发症发生率无显著差异。
与单纯TTE相比，经食管超声心动图和3D打印在引导经导管封堵PVL方面具有优势，手术和透视时间更短。这种微创治疗可为选定患者提供可靠的治疗效果。
